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IDR outcomes

How disputes went where you practice

Pick a state and a period. The page reads the decisions back to you: how many, how they went, what the award was against the payer's rate, how long they took, and who was on the other side. Every figure carries its count; nothing under 11 line items is shown.

The briefing

Over the latest four quarters (2025 Q1 to 2025 Q4), nationally, arbiters decided 5,722,653 line items in 2,180,938 disputes. Providers won 86% of the 1,753,288 contested ones; 20% of disputes were decided by default because one side made no offer or paid no fee. The median award was 4.0× the payer's rate, with the middle half of awards between 2.2× and 8.1×; payers' own final offers had a median of 1.00×. In dollars, the median award was $611 against a median payer's rate of $159 and a median first payment of $95. A decision took a median 31 business days; 50% came within 30.

5,722,653
line items decided2,180,938 disputes
86%
of contested disputes won by the provider1,753,288 contested
4.0×
the payer's rate: the median awardmiddle half 2.2× to 8.1×
31
business days to a decision, median50% within 30
$611
median award in dollarspayer's rate $159 · paid first $95

31% of disputes were batched; the median dispute carried 1 line item.

The full tables and charts are easiest to read on a larger screen. On a phone, start with the figures above, or ask for a free claims review and we will read your own remittances for you.

01Over time

Line items decided per quarter, and the share providers won

Every quarter, national. Bars are line items decided; the line is the share of contested disputes the provider won.

'23 Q1: 65,231 line items, 75% won by providers'23 Q2: 113,043 line items, 85% won by providers'23 Q3: 76,525 line items, 81% won by providers'23 Q4: 78,425 line items, 89% won by providers'24 Q1: 186,469 line items, 88% won by providers'24 Q2: 377,629 line items, 84% won by providers'24 Q3: 660,595 line items, 85% won by providers'24 Q4: 944,900 line items, 85% won by providers'25 Q1: 1,112,854 line items, 86% won by providers'25 Q2: 1,629,014 line items, 87% won by providers'25 Q3: 1,573,101 line items, 85% won by providers'25 Q4: 1,407,684 line items, 83% won by providers'23 Q1: 75% won by providers'23 Q2: 85% won by providers'23 Q3: 81% won by providers'23 Q4: 89% won by providers'24 Q1: 88% won by providers'24 Q2: 84% won by providers'24 Q3: 85% won by providers'24 Q4: 85% won by providers'25 Q1: 86% won by providers'25 Q2: 87% won by providers'25 Q3: 85% won by providers'25 Q4: 83% won by providers'23 Q1'23 Q3'24 Q1'24 Q3'25 Q1'25 Q3'25 Q4

02Where, and what

Where the disputes are

The twenty states with the most line items, with each one's provider win rate and median award against the payer's rate. Pick a state to filter the page; pick it again to go back to national.

What was disputed, and who won

CMS's service-code ranges. Contested line items only; the count is every line item in the group.

03Kinds and codes

By kind of service

The seven kinds the IDR calculator uses.

Emergency and critical care visits1,949,52785%3.21×2.0× to 5.4×
Radiology1,092,51189%4.71×2.8× to 7.6×
Pathology and laboratory811,37479%4.50×2.2× to 9.0×
Anesthesia359,33083%3.26×2.0× to 8.2×
Surgery292,62886%14.10×3.9× to 49.5×
Other visits and medicine750,45684%6.42×2.6× to 18.6×
Other services466,82778%3.78×1.6× to 8.7×

The most disputed codes

Twenty-five codes by line items. Each opens the code's own page.

7045067,74489%4.7×
71045112,84289%5.9×
7104669,51985%7.2×
7417644,86786%6.2×
7417795,22587%6.3×
7706374,61195%2.5×
7706779,90495%2.9×
8005375,38981%5.1×
8100348,62278%6.4×
8448436,43781%3.8×
8502595,52080%4.4×
9300540,91082%3.4×
9301036,62186%6.3×
9593858,69785%37×
9593932,65284%17×
9594139,39885%13×
9636143,48381%4.4×
9637235,19578%4.1×
9637444,67281%3.4×
9637549,53482%4.9×
99283269,36381%3.8×
992841,006,56885%3.3×
99285585,99187%2.9×
9929176,60088%3.4×
0081250,96983%4.2×

04Who was on the other side

Payers

Grouped by the email domain CMS reports; names in mono type are domains whose owner has not been confirmed. "Payer's offer ÷ its rate" is the median of the payer's own final offers.

UnitedHealthcare1,241,849551,05585%3.7×1.00×
Blue Cross and Blue Shield of Texas1,197,912373,64885%6.1×1.00×
Aetna847,212316,76692%4.0×1.00×
Claritev (formerly MultiPlan)529,750221,07781%4.2×2.4×
Cigna Healthcare327,28478,77882%2.7×1.25×
Anthem320,368167,45087%3.6×1.00×
Blue Cross Blue Shield of Arizona147,03644,17381%5.6×1.99×
Centene129,35421,48494%2.9×1.00×
Florida Blue74,45934,03991%3.2×1.00×
Blue Cross and Blue Shield of Illinois74,17032,71484%5.0×1.00×
Blue Cross and Blue Shield of New Mexico40,73814,30898%5.2×1.00×
Zelis34,0908,60884%2.9×1.25×
Blue Cross and Blue Shield of Louisiana22,13011,82251%3.6×1.09×
Blue Cross and Blue Shield of Oklahoma19,2339,33696%13×1.42×
Blue Shield of California17,9858,71277%5.9×1.00×
Oscar Health15,8513,90393%4.2×1.00×
springtidehealth.com14,7465,68960%2.0×1.00×
Blue Cross and Blue Shield of Kansas14,1685,05292%2.9×1.00×
bcbst.com11,8474,78473%2.5×1.05×
EmblemHealth11,2967,72988%19×8.9×

Arbiters

The certified IDR entities, named in the files from 2025 Q3. Fees are per party per dispute from CMS's current list; the median fee paid is what the losing party actually paid, from the files.

Federal Hearings and Appeals Services (FHAS)260,84479%3.9×20$435$525 / $695
C2C Innovative Solutions129,91688%3.9×33$575$485 / $685
Provider Resources123,55095%4.1×44$498$518 / $660
IPRO102,36999%5.2×23$740$740 / $1,075
MCMC Services83,58592%4.0×25$388$470 / $790
EdiPhy Advisors75,12191%4.7×18$800$800 / $1,150
Maximus Federal Services76,09091%7.0×21$495$495 / $750
Network Medical Review Company44,00471%3.0×49$389$450 / $750
iMPROve Health71,00186%3.3×38$500$500 / $850
National Medical Reviews41,90771%2.7×24$425$525 / $625
MET Healthcare Solutions (Medical Evaluators of Texas)33,61651%2.1×18$375$425 / $700
Acentra (Keystone Peer Review Organization)33,90085%3.8×26$600$650 / $850
ProPeer Resources28,87652%2.5×19$600$570 / $770
Capitol Bridge10,25266%3.5×27$595$595 / $795
Commence (Livanta)9,36359%2.7×32$690$690 / $1,095

By plan type

As the plan reported it.

By practice size

Employees of the filing practice or facility.

Single and batched disputes

Batching spreads the fees over several lines.

Source: Centers for Medicare & Medicaid Services. Federal IDR Public Use File [Data file and data dictionary]. Retrieved from https://www.cms.gov/nosurprises/policies-and-resources/reports. Spectare Health's reading; national public data about federal disputes, not Spectare's results. Default decisions are excluded from win rates and counted separately. Multiples use the payer's rate as the filer reported it; rows with no reported rate are excluded. Data version 2025Q4-166d8d. How we count.

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